Government Programs Specialist

HealthSpring is one of the largest managed care organizations in the U.S. with a primary focus on the Medicare Advantage market. Under the Medicare Advantage program, Medicare beneficiaries receive healthcare benefits through a managed care health plan. HealthSpring’s concentration on Medicare Advantage provides it with opportunities to understand the complexities of the Medicare program, design competitive products, manage medical costs, and offer high-quality healthcare benefits to Medicare beneficiaries in its local service areas.



We are seeking a Government Programs Specialist to join for our Government Programs Department. In this key position you will be responsible for providing timely and accurate guidance to health plan departments related to federal rules and regulations. You will act as liaison between the health plan and Centers for Medicare and Medicaid Services (CMS), and ensure that special projects are completed as needed.

To meet the challenges of this position you must possess a minimum of 2 years of experience in any combination of claims operations, medical coding/billing, physician/hospital administration, provider contracting, and eligibility or legal service, along with managed care or hospital administration, a working knowledge of Medicare is preferred. Bachelor’s degree in a related field is required, (4 years experience would be considered in lieu of the degree).

 The responsibilities and functions of this position are to: Coordinate communications between the health plan and CMS Provide regulatory oversight as it related to the interpretation, adherence & distribution of state and federal regulations. Review all member and marketing materials prior to submission to CMS to ensure compliance with requirements File Annual Plan Benefit Approval & Applications/Renewals, Service Area Expansion, Evidence of Coverage, Annual Notice of Coverage, Summary of Benefits and other documents Distribute CMS – approved letters, documents and notices to appropriate departments Review policies and procedures for departments to ensure compliance with current regulations Attend operations meetings monthly to deliver Government Program updates to various departments Attend Quality Improvement Committee (QIC) meetings; submit executive summary of regulatory and other government program activity for previous month Assist with development and delivery of training materials as needed Assist with internal and CMS audits as needed

At HealthSpring you’ll enjoy a professional yet casual working environment. We recognize that our most valuable asset is our people and the bottom line to our company success is our employees. You will find the pace here fast, fun and exhilarating. In our organization you have the opportunity to “Be the Best at Making People Better�   HealthSpring offers a competitive salary and a full range of benefits. HealthSpring is an EEO/AA employer.